1. California Stroke Registry Right Care Initiative Meeting August 13, 2012

2. 2 Background Assembly Bill 1220 (Berg, 2003) Governor-appointed Task Force California’s Master Plan for Heart Disease and Stroke Prevention and Treatment 2007-2015 – Recommends the development of systems of care for acute heart attack and stroke

3. 3 Master Plan Recommendations Goal: Reduce death and disability from heart disease and stroke through early detection, treatment, and management of acute events. Establish: – Standards for pre-hospital patient assessment – Protocols for preferential transport to designated centers – Criteria for certification of receiving hospitals – Standards for appropriate acute treatment – Continuity of care through linkages between hospitals – Stroke and STEMI System Work Groups to address development of statewide systems of care

4. 4 Statewide Plans

5. 5 Master Plan Recommendations Goal: Expand data acquisition and surveillance of cardiovascular disease, including evaluation of programs targeting heart disease, stroke, and related risk factors. Strategies: – Create statewide database to monitor pre-hospital care for acute coronary syndrome and stroke. Utilize data for QI, evaluation of strategies, and evaluation of public education programs.

6. California Stroke Registry Collaborative project since 2007 – California Heart Disease and Stroke Prevention Program – American Heart Association/ American Stroke Association 6

7. CSR Purpose Measure and track acute stroke care in California hospitals. Monitor progress of statewide system of stroke care. Repository of stroke data to promote quality improvement for acute stroke treatment. 7

8. CSR Objectives Decrease the rate of premature death and disability from acute stroke through secondary prevention. Increase public awareness of stroke treatment and prevention. Reduce disparities in acute stroke care by providing underserved populations with better access to treatment. 8

9. 9 CSR Advisory Committee Convened in October 2007 11 voluntary members (current) Stroke neurologists, stroke coordinators, cardiovascular health epidemiologists, administrators, state QIO representative Members have expertise in stroke treatment, epidemiology/science, and/or the design of the CDC ‑ sponsored California Acute Stroke Pilot Registry Telestroke subcommittee

10. CSR Recruitment Strategy I – 2008 – GWTG hospitals Strategy II – 2009 – Other Data Systems – Collaboration with California Cancer Registry (CCR) Strategy III – 2010 – Systems of Care – Data Collection System 10

11. 11 CSR and CCR/Eureka Partnership with the California Cancer Registry (CCR) – Eureka system Two decades of experience with data collection Integrated data platform for the collection and integration of hospital data from multiple data collection tools Standardization of data elements from various systems Report generation

12. 12 CSR-Eureka: Expansion for LEMSAs CSR-Eureka Report Portal is designed to assist LEMSAs with assessments of stroke systems and education/training of EMS staff Hospitals upload data directly to CSR through CSR- Eureka platform Features include: – Fixed reports – Customized reports – Raw Data

13. 13 Telestroke Networks CSR Telestroke Subcommittee – Currently developing a set of data elements to be collected by “spoke” hospitals CSR-Eureka data platform will allow: – Easier data submission from spoke hospitals to hub hospital – Report generation

14. 14 Pre-Hospital Data Elements Incident or onset Date/Time PSAP call Date/Time Unit notified by dispatch Date/Time Unit arrived at patient Date/Time Unit left scene Date/Time Patient arrived at destination Date/Time Stroke scale Thrombolytic screen Destination/transferred to, name Reason for choosing destination Provider’s primary impression Provider’s secondary impression

15. 15 CSR Data Elements Arrival and Admission Information Demographics Medical History Diagnosis and Evaluation Medications Prior to Admission Symptom Timeline Brain Imaging IV Thrombolytic Therapy In Hospital Treatment and Complications Discharge Diagnosis Discharge Treatments Stroke Rehabilitation

16. CSR Status July 2012 Total number of cases entered – 62,402 Total number of hospitals participating – 46 Total number of Primary Stroke Centers in California – 124 TJC; 2 HFAP 16

17. Funding CDC State Heart Disease and Stroke Prevention Program – $120,000 (2009) – $150,000 (2010) July 2012– Paul Coverdell National Acute Stroke Registry – 11 states – In-hospital care and EMS – 3-year award – $350,000 per year 17

18. Quality Improvement Activities CSR Collaborative for Northern California – Annual event for CSR hospital staff located in N Cal – Provides a forum to share best practices, discuss issues related to stroke care, learn from colleagues, and network Hospital QI calls (data and clinical) – One-on-one QI calls with stroke coordinators – Periodic group calls with CSR hospitals to present/discuss data QI issues and best practices 18

19. EMS Activities Regional Stroke Data Committee – Bay Area LEMSAs, CSR, and AHA/ASA – Developed set of pre-hospital data elements Consultations and one-on-one meetings/calls with LEMSAs – Development of stroke systems of care – Data collection, data reports, data sets EMS training and QI 19

20. Presentations CDC’s National Heart Disease and Stroke Prevention Program (Atlanta, September 2010) CDC’s Coverdell Technical Workshop (Atlanta, September 2010) American Stroke Association’s International Stroke Conference (Los Angeles, February 2011) American Public Health Association Annual Conference (Washington, DC, October 2011) American Public Health Association Annual Conference (San Francisco, October 2012) 20

21. CSR 2012 and Beyond Hospital data reports Pre-hospital data Quality improvement Recruitment of new hospitals Funding opportunities 21

22. 22 Contact Information California Heart Disease and Stroke Prevention Program Heart@cdph.ca.gov or (916) 552-9099 www.cdph.ca.gov/programs/CVD California Stroke Registry csr@cdph.ca.gov or (916) 552-9099